Leadex Corporation Bid FormsThis proposal is being submitted by Leadex Corporation not only located
within three miles of the City of South Miami but the principal Frank J
Fonseca, P. E. and son Nelson Fonseca, P. E. have been residents of the City
of South Miami continuously since 1977.
Leadex Corporation has completed projects the City of South Miami since
inception in 1990, mainly in Parks and recreation buildings and is familiar
with the necessity of the Public access to parks and to keep it safe while in
construction.
The proposed playground equipment is manufactured • BCI Burke, the
oldest playground manufacturer in the USA (95 years).
All components of playground equipment are manufactured in the USA
according and meeting all current ASTM, Ipema certification, etc. All
playground equipment will be installed under strict supervision of
professional Engineers and Certified Playground Safety Inspector (CPSI).
All mulch to be used is manufactured in the USA and meet stringent ASTM
for fall heights and ADA accessibility codes.
Summary: The playground and components are w in the
USA and installed by local personnel, some residing in the City of South
Miami since 1977 and will take pride in a successful completion on time and
on budget.
Thank you for the opportunity to present our proposal for your review and
evaluation.
fJ
Proposal Submittal Checklist Form
This checklist indicates the forms and documents required to be submitted for this solicitation and to be presented
by the deadline set for within the solicitation. Fulfillment of all solicitation requirements listed is mandatory for
consideration of response to the solicitation. Additional documents may be required and, if so, they will be
identified in an addendum to this RFP. The response shall include the following items:
X Bid Form
NIA Proposal /Bid Bond
X *Performance Bond (As a Condition of Award; Not
Required With the Submittal)
X
Respondents Qualification Statement
X Non - Collusion Affidavit
X Public Entity Crimes and Conflicts of Interest
X Drug Free Workplace
X Acknowledgement of Conformance with OSHA Standards
X List of Proposed Subcontractors and Principal Suppliers
X Related Party Transaction Verification Form
X Indemnification and Insurance Documents
X Signed Contract Documents (All — including General Conditions
and Supplementary Conditions)
NIA
M
* Performance Bond: Required as a Condition of Award and Prior to the Contractor Receiving
a Notice to Proceed. Not Required with Submittal.
Submit this checklist along with your proposal indicating the completion and submission of each required forms
and /or documents.
END OF SECTION
Page 10 of 80
Thomas F. Pepe
12 -S -14
r
THIS PROPOSAL IS SUBMITTED TO:
Steven Alexander
City Manager
City of South Miami
6130 Sunset Drive
South Miami, FL 33143
1. If this .Proposal is accepted, the undersigned Respondent agrees to enter into a Contract with the City of
South Miami in the form included in this RFP Package, and to perform and furnish all work as specified or
indicated in this RFP for the Proposed Price, within the Contract Time and in accordance with the other
terms and conditions of the RFP Package.
1 Respondent accepts all of the terms and conditions of the RFP, Invitation for Proposals and Instructions to
Respondents, including without limitation those dealing with the disposition of Proposal /Bid Bond. This
Proposal will remain subject to acceptance for 180 calendar days after the day of the Proposal Opening.
.Respondent agrees to sign and submit the Contract, if not already submitted, the Bonds, required
insurance documents, and other documents required by the RFP, within ten (10) calendar days after the
date of the City's Notice of Award.
3. In submitting this Proposal, Respondent represents that:
a. Respondent has examined copies of all the RFP Documents and of the following Addenda, if any
(receipt of all which is hereby acknowledged.)
r
Addendum No. Dated:
Addendum No.
r
Dated:
f Jj
.....:Addendum No.
..
bated:
f I J �1
Addendum No.
1 t
Dated:
,1` ! s� Zx
Addendum No.
.,r�V _
- - - -- Dated:
.:Addendum No.
_ t,a
Dated:
b. Respondent has familiarized himself with the nature and extent of the Contract Documents, the
proposed work, site, locality, and all local conditions and laws and regulations that in any manner
may affect cost, progress, performance or furnishing of the Work.
:c Subsurface conditions: If applicable to this RFP, the Respondent represents that:
3. Respondent has studied carefully all reports and drawings, if applicable, of subsurface
conditions and drawings of physical conditions.
ii. .Respondent has obtained and carefully studied (or assumes responsibility for abstaining and
carefully studying) all such examinations, investigations, explorations, tests and studies in
addition to or to supplement those referred to in this paragraph which pertain to the
subsurface or physical conditions at the site or otherwise may affect the cost, progress,
performance, or the furnishing of the Work at the Contract Price, within the Contract Time
and in accordance with the other terms and conditions of the Contract .Documents. The
Respondent hereby acknowledges that no additional examinations, investigations,
explorations, tests, reports or similar information or data are, or will, be required by
Respondent for any reason in connection with the Proposal. The failure of the .Respondent
to request a pre -bid marking of the construction site by any or all utility companies shall
create an irrefutable presumption that the Respondent's bid, or proposal price, has taken
into consideration all possible underground conditions and Respondent, if awarded the
Page I I of 80
Thomas F. Pepe
12 -5.14
contract, shall not be entitled to a .change order- for any such condition discovered
thereafter.
iii: :Respondent has correlated the results of all such observations, examinations, investigations,
explorations, tests, reports and studies with the terms and conditions of the Contract.
Documents;
iv. Respondent has reviewed and checked all information and data shown or indicated in the
RFP Package or in the Contract Documents with respect to existing Underground Facilities
or conditions at or contiguous to the site and assumes responsibility for the accurate
location of all Underground Facilities and conditions that may affect the Work. No
.additional examinations, investigations, explorations, tests, reports or similar information or
data in respect to any Underground Facilities or conditions are, or will be, required by
Respondent in order to perform and furnish the Work at the Contract Price, within the
Contract Time and in accordance with the other terms and conditions of the Contract.
.Documents unless the Proposal specifically states that the contract price is subject to
adjustment for future discovery of underground facilities and/or conditions that affect the
cost of the Work and unless the respondent makes a written request to the City for
additional information prior to submitting the bid or proposal as required in subsection ii
above,
d. Respondent has given the City written notice of all conflicts, errors or discrepancies that it has
discovered in the Contract Documents and, if any conflicts, errors or discrepancies have been
found and notice given, the Respondent represents; by submitting its proposal to the City, that
the Respondent has .received sufficient notice of the resolution thereof from the City, that such
resolution is acceptable to Respondent and that the Respondent waives any claim regarding the
conflicts, errors or discrepancies.
e. This Proposal is genuine and not made in the interest: of or on behalf of any undisclosed person,
firm or corporation and is not submitted pursuant to any agreement or rules of any group,
association, organization, or corporation; Respondent has not directly or indirectly induced or
solicited any other Respondent to submit a false or sham Proposal; Respondent has not solicited
or induced any person, firm or corporation to refrain from responding; and Respondent has not
sought by collusion or otherwise to obtain for itself any advantage over any other Respondent or
over the CITY.
4. Respondent understands and agrees that the Contract Price is the amount that it needs to furnish and
install all of the Work complete and in place. The Schedule of Values, if required, is provided for the
:purpose of Proposal Evaluation and when initiated by the CITY, it shall form the basis for calculating the
pricing of change orders. The Contract Price shall not be adjusted in any way so as to result in a
deviation from the Schedule of Values, except to the extent that the CITY changes the scope of the
Work after the Contract Date. As such, the Respondent shall furnish all labor, materials, equipment,
tools, superintendence and services necessary to provide a complete, in place, Project for the .Proposal
Price of:
LUMP SUM BASE PRICE: 2y111) 1A y.='Rf.t' ,Y:X ;
dollars and 0 0
1YrrY f 1 0005CIlY2
cents $ a + %01
Alternates: #1 / }- /). #5
#2 #b
#3 #7 _
#4
Page 12 of 80
Thomas F. Pepe
12.5.14
#t8
A fee breakdown, if applicable, for each task must be completed In the table shown above; Failure to
complete this information shall render the proposal non - responsive.
S. The ENTIRE WORK shall be completed, in full, within p slays from the date stipulated to the NOTICE
TO PROCEED. Failure to complete the entire work during the described time period shall result In the
assessment of liquidated damages as set forth in the Contract.
6. Communications concerning this Proposal shall be addressed to:
RESPONDENT: LEADEX CORPORATION
- .Address:
MIAMI, FL 33155
Telephone: 305-266-2028
Facsimile: - -
Atcention: FRANK J. FONSECA, P.E.
7; The terms used in this Proposal which are defined In the Contract shall have the same meaning as is
- assigned to them in the Contract Documents, unless specifically defined in this RFP Package.
8. By submitting this proposal, I, on behalf of the business that I represent, hereby agrees to the terms of the
form of contract contained In the RFP package and I agree to be bound by those terms, with any
appropriate blank boxes, if any, checked and any blank lines filled in with the appropriate information
Contained in the Solicitation Documents and this Proposal, or such Information that the City and I have
agreed upon In the course of contract negotiations and which have been confirmed by the City in writing,
Including any e•maii confirmation, if any,
SUBMITTED THIS 27TH DAY OF JANUARY 2015 .
PROPOSAL SUBMITTED BY:
LEADER CORPORATION 305 -266 -2028
Company Telephone Number
FRANK J. FONSECA P.E. PRESIDENT "305 -264 -5350
Name of Person Authorized to Submit Fax Number
Proposal 1
frank(cr�,leadexcorp.com
Signature Email Address
President
Tide
END OF SECTION
Page 13 of 88
Thomas F. Pepe
12.5.14
NOTE: NOT REQUIRED FOR THIS PROJECT
"Playground Demolition and New Installation at Four (4) City Parks"
PROPOSAUBID BONS
STATE OF FLORIDA )
- COUNTY OF MIAMI -DADE ) j
KNOW ALL MEN BY THESE PRESENTS, that we;
as Principal, and
as Surety, are held and firmly bound unto the City of South Miam) ( "City "), a
municipal corporation of the State of Florida in the sum of
Dollars I$ ), lawful money of the United States, for the payment of which sum well and
truly to be made, we bind ourselves, our heirs; executors, administrators and successors joihdy and severally,
firmly by these presents.
THE CONDITION OF THIS OBLIGATION IS SUCH that:
WHEREAS, the Principal has submitted the accompanying Proposal dated ._' „ for
the pursuant to an RFP and a condition precedent to the
submission of said Proposal is that a Proposal /Bid Bond in the amount of five percent (5 %) of the Base Proposal be
submitted with said Proposal as a guarantee that the Respondent would fulfill the obligations set forth in the RFP
and proposal documents;
NOW THEREFORE,
A. If the principal shall not withdraw said proposal within one hundred eighty (160) calendar days after the
date for opening of the same, and shall, within ten (10) calendar days after the prescribed forms are presented to it
for signature, sign a written contract with the City in accordance with the Solicitation Documents and proposal as
:accepted by the City, and give bonds with good and sufficient surety or sureties, as maybe required, for the
faithful performance and proper fulfillment of such contract, and provide proof of insurance as required, then the
:above obligations shall be void and of no effect, otherwise to remain in full force and effect.
B. However, in the event of the principal's unauthorized withdrawal of said proposal within one hundred
:eighty (160) calendar days after the date of the opening of the same or the failure to a written contract with the
Owner in accordance with the proposal as accepted, and %or the failure to provide the City with bonds issued from
good and sufficient surety or sureties, as may be required, for the faithful performance and proper fulfillment of
such Contract and proof of insurance within ten (IOj calendar days after the prescribed forms . are presented to it
for signature and/or in the event that the principal,is not awarded the project but fails to waive all claims that arose
or might have arisen out of the RFP process, then the above obligations shall remain in full force . and effect and the
bond shall thereafter be disburse, by court order, to the Owner in the full amount of the bond if the Proposal
Documents provide for liquidated damages under the circumstance of the case or, if liquidated damages are not
applicable, then in an amount that is adequate to fully compensate the Owner for all of its damages incurred due to
the breach of the terms of this Band, including all: attorney fees, court costs and legal expense incurred by the City
for any and all action taken, whether before or after the commencement of legal 'proceedings, including
proceedings required to obtain the court order of disbursement, including the cost of all appeals or other related
proceedings, as well as the fees and , costs incurred to collect these damages.
IN WITNESS WHEREOF, the above bonded parties have executed this instrument under their
:several seals this ;, day of ; 20_, the name and the corporate seal of
each corporate party being her`eto affixed and these presents being duly signed by its undersigned representative.
(Seal)
(Individual or Partnership Principal)
Page 14 of 80
Thomas F. Pepe
12.5 -14
(Business Address)
(City/State /Zip)
(Business Telephone)
ATTEST:......
Secretary (Corporate Surety)*
By'
*Impress Corporate Surety Seal
IMPORTANT Surety companies eXecuting bonds must appear on the Treasury Department's most current list
(circular 570 as amended) and be authorized to transact business in the State of Florida.
FAILURE TO COMPLETE SIGN &RETURN THIS FORM MAY DISCaUALIFY YOU
By:
r,
Page IS of Stt
Thomas F. Pepe
12-5-14
3. Current workload
4. The following Information shall be attached to the proposal.
a) RESPONDENT's home office organization chart
b) RESPONDENT's proposed project organizational chart.
c) Resumes of proposed key project personnel, including on -site Superintendent.
S. last and describe any:
AL./=r Y7
a) Bankruptcy petitions filed by or against the Respondent or any predecessor organizations,
fa) Any arbitration or civil or criminal proceedings, or
Suspension of contracts or debarring from Bidding or Responding by any public agency brought
c) against the Respondent in the last five (5) years
6. Government References:
List other Government Agencies or Quasi - government Agencies for which you have done business within
the past five (5) years.
Name of Agency: MIAMI DADE HOUSING AGENCY
Address: 701 NW 1ST CT MIAMI, FL 33125
Page 22 of 00
Thomas F. Pepe.
.12.5 -14
Telephone No--
786- 469- 41281786 -469 -4127
Contact Person:
JOSE ALVAREZ /LISSETTE MARTINEZ
Type of Project:
PLAYGROUNDS (LIBERTY SQUARE)
Name of Agency:
CITY OF CORAL GABLES
Address:
2800 S W 72 AVE., MIAMI, FL 33155
Telephone No.:
(305) 460 -5000
Contact Person:
ERNESTO PINO
Type of "ect:
PLAYGROUND, BASKETBALL COURT, TRELLIS, ETC.
(SUNRISE PARK)
Name of Agency:
SCHOOL DISTRICT OF PALM BEACH COUNTY
Address:
3661 INTERSTATE PARK ROAD NORTH STE 200 RIVIERA BEACH, F
33404
Telephone No-
561- 722 -3045
Contact Person:
STEVEN FLEMING
Type of Project:
PLAYGROUND SURFACING
END OF SECTION
Page 23 of 80
Thomas F. Pepe
IZ -S -14
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LEADEX CORPORATION
2601 S W 69TH CT.
MIAMI, FL 33155
ORGANIZATION CHART
PROPOSED PROJECT
FRANK ] FONSECA, P.E.
PRESIDENT
NELSON D. FONSECA, P.E., CPSI
PROJECT MANAGER
PEDRO J. GOMEZ MAURO HERNANDEZ
Plavaround Construction Sitework Construction
Expertise of Designated Staff:
Frank J Fonseca, President
University of Miami BSME 1964
Professional Engineer 1966
State General Contractor 1977
State Mechanical Contractor 1977
Certified Playground Safety Inspector
Extensive experience in all phases of Construction and Industrial operations,
including Accounting and Financial. Founded Leadex Corporation in 1990 and
has successfully established this Corporation as a full service General
Contracting and Mechanical Contracting firm, having presently over 40 full time
employees. Leadex Corporation has been a leader in the parks and recreation
construction specializing in playgrounds.
e -mail: frank(W-leadexcorp.com Cellular Phone: 305.345.7474
Nelson D. Fonseca, P. E.
Rensselaer BSCE 1997
Professional Engineer State of Florida
Certified Playground Safety Inspector
Leadex Corporation's appointed Sr. design engineer for this contract will be
Nelson D. Fonseca.
Nelson has over fifteen years of experience in design and construction of major
structures. He has designed projects from playgrounds to bridges. He is a
Professional Engineer and the design professional for Leadex Corporation.
Nelson has developed a close relationship with the design department of the
Playground manufacturers to ensure quality from the conceptual phase. He is
very fluent in CAD and other design programs to accomplish the design in a
timely fashion. His experience also includes the design and construction of
buildings and 40 years Recertification of Structures.
e -mail: Nelson _leadexcorp.com Cellular Phone: 305.301.9627
Pedro J. Gomez, superintendent
Mr. Gomez has been with Leadex Corporation since it started in February 1990.
Mr. Gomez throughout the years has completed over 500 playgrounds and
several complete Parks including Splash pads, Community buildings, xxx for
buildings, parking and other miscellaenous construction and remodeling work for
several municipalities and Schools in Dade, Monroe, Broward, Palm Beach and
St Lucie County. Always on time and on budget.
Mauro Hernandez, Superintendent
Mr. Hernandez has been with Leadex since 1996 and has succesfully completed
many playground installations and complete site work. He also completed new
and remodeling construction work for some private clients but mostly for
Government entities as City of Miami Retirement Trust, Miami Dade Housing
agency, Miami Dade County School Board, Broward County Parks and many
other municipalities. Always on time and budget.
.r
FRANK J FONSECA, P.E. being first duly sworn, deposes and states that:
(1) Hef5he/Theyis /are the PRESIDENT
(Owner, Farmer, Mar, Representative or Agent) of
LEADEX CORPORATION the Respondent that has submitted the
attached Proposal;
(2) He/She/They Islare fully informed concerning the preparation and contents of the attached Proposal
and of a0 pertinent circumstances concerning such Proposal;
(3) Such Proposal is genuine and is not a collusive or sham Proposal;
(4) Neither the said Respondent nor any of its officers, partners, owners, agents, representatives,
:employees or parties In interest, Including this afflant, have In any way colluded, conspired, connived
or agreed, directly or Indirectly, with any other Respondent, firm, or person to submit a collusive or
sham Proposal In connection with the Work for which the attached Proposal has been submitted; or
to refrain from Bidding or proposing In connection with such Work; or have in any manner, directly
or indirectly, sought by agreement or collusion, or communication, or conference with any
Respondent, firm, or person to fix any overhead, profit, or cost elements of the Proposal or of any
other Respondent, or to fix any overhead, profit, or cost elements of the Proposal Price or the
Proposal Price of any other Respondent, or to secure through any collusion, conspiracy, connivance,
or unlawful agreement any advantage against (Recipient), or any person Interested in the proposed
Work;
(5) The price or prices quoted in the attached Proposal are fair and proper and are not tainted by any
collusion, conspiracy, connivance, or unlawful agreement on the part of the Respondent or any other
of its agents, representatives, owners, employees or parties of interest, including this affiant.
Signed, sealed and delivered in the pres ce of:
By: _-
Witness 5ignatu
FRANK J FONSECA P.E. PRESIDENT
ss Print Name and Tide
01127/2015
Date
Page 26 of SO
Thomas F. Pope
.12.5.14
ACKNOWLEDGEMENT
STATE OF FLORIDA )
COUNTY OF MIAMI -DADE
.' j. r't.
On this the day of J YVc,, ,iw'
, 20/, before me, the undersigned Notary Public of the State
of Florida personally appeared (Namvidual(s)
who appeared before
notary)
and whose name(s) is /are Subscribed to the
:within instrument, and he /she(they acknowledge
that he /she /they executed it.
r }yXt6
WITNESS my hand and official seal.
° +t
,iNota
ge _ All
NOTARY PUBLIC:
IN SSM # FF 134737
EXPIRES :J*7,2018
ihm ice}' Pdre Undamlm
SEAL OF OFFICE:
(Name of Notary Public: Print, Stamp or type as
commissioned.)
Personally known to me, or
Personal identification:
Type of Identification Produced
Did take an oath, or
Did Not take an oath.
Page 27 of 80
Thomas. Pepe
IM-14
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PUBLIC ENTITY CRIMES AND CONFLICTS OF INTEREST
Pursuant to the provisions of Paragraph (2) (a) of Section 287.133, Florida State Statutes — "A person or affiliate
who has been placed on the convicted vendor list following a conviction for a public entity crime may not submit a
Proposal or bid on a Contract to provide any goods or services to a public entity, may not submit a Bid or
proposal for a Contract with a public entity for the construction of repair of a public building or public work, may
not submit bids or proposals on leases or real property to a public entity, may not be awarded to perform Work
as a RESPONDENT, Sub - contractor, supplier, Sub - consultant, or Consultant under a Contract with any public
entity, and may not transact business with any public entity in excess of the threshold amount Category Two of
Section 287.017, Florida Statutes, for thirty six (36) months from the date of being placed on the convicted vendor
list".
The award of any contract hereunder is subject to the provisions of Chapter 112, Florida State Statutes.
Respondents must disclose with their Proposals, the name of any officer, director. partner, associate or agent who
Is also an officer or employee of the City of South Miami or Its agencies.
SWORN STATEMENT PURSUANT TO SECTION 287.133 (3) (a),
FLORIDA STATUTES. ON PUBLIC ENTITY CRIMES
THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER
OFFICIAL AUTHORIZED TO ADMINISTER OATHS.
1. This sworn statement is submitted to
CITY OF SOUTH MIAMI
[print name of the public entity]
by FRANK J FONSECA, P.E PRESIDENT
[print Individual's name and title]
for LEADEX CORPORATION
[print name of entity submitting sworn statement]
whose business address is 2601 S W 69TH CT.
MIAMI, FL 33155
and (if applicable) its Federal Employer Identification Number (FEIN) is 65- 0170950 (If the
entity has no FEIN, Include the Social Security Number of the Individual signing this sworn statement:
2. 1 understand that a "public entity crime" as defined In Paragraph 287.133 (1)(g), Florida Statutes .
means a violation of any state or federal law by a person with respect to and directly related to the
transaction of business with any public entity or with an agency or political subdivision of any other state
or of the United States, including, but not limited to , any bid, proposal or contract for goods or services
to be provided to any public entity or an agency or political subdivision of any other state or of the
United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material
misrepresentation.
3. 1 understand that "convicted" or "conviction" as defined in Paragraph 287.133 (1) (b), Florida
Statutes means a finding of guilt or a conviction of a public entity crime, with or without an adjudication
of guilt, in any federal or state trial court of record relating to charges brought by indictment or
information after July I, 1989, as a result of a jury verdict, non-jury trial, or entry of a plea of guilty or
nolo contendere.
4. 1 understand that an "affiliate" as defined in Paragraph 287.133 (1) (a), Florida Statutes, means:
(a) A predecessor or successor of a person convicted of a public entity crime; or
Page 28 of 80
Thomas F. Pepe
12.5.14
(b) An entity under the control of any natural person who is active in the management of the entity
and who has been convicted of a public entity crime. The term "affiliate" includes those officers,
directors, executives, partners, shareholders, employees, members, and agents who are active in
the management of an affiliate. The ownership by one person of shares constituting a controlling
interest in any person, or a pooling of equipment or income among persons when not for fair
.market value under an arm's length agreement, shall be a prima facie case that one person
....controls another person. A person who knowingly enters into a joint venture with a person
who has been convicted of a public entity crime in Florida during the preceding 36 months shall
be considered an affiliate.
5. 1 understand that a "person' as defined in Paragraph 287,133 (1) (e), : Morida Statutes, means any
"natural person or entity organized under the laws of any state or of the United States with the legal
.power to enter into a binding contract and which bids or proposal or applies to bid or proposal on
contracts for the provision of goods or services let by a public entity, or which otherwise transacts or
:applies to transact business with a public entity. The term "person' includes those officers, directors,
executives, partners, shareholders, employees, members, and agents who are active in management of an
entity.
6. Based on information and belief, the statement which I have marked below is true in relation to the
entity submitting this sworn statement. [indicate which statement applies.]
-' Neither the entity submitting this sworn statement,: nor any of its officers, directors, executives,
partners, shareholders, employees, members, or agents who are active in the management of the entity,
.nor any affiliate of the entity has been charged with and convicted of a public entity crime subsequent to
July 1, 1989.
—The entity submitting this sworn statement, or one or more of its officers, directors, executives,
partners, shareholders, employees, members, or agents who are active in the management of the entity,
or an affiliate of the entity has been charged with and convicted of a. public entity crime subsequent to July
I, 1989.
—The entity submitting this sworn statement, or one or more of its offcers, . directors; executives,
partners, shareholders, employees, members, or agents who are active in the management of the entity,
or an affiliate of the entity has been charged with and convicted of apublic entity crime subsequent of July
1, 1989. However, there has been a subsequent proceeding before a Hearing Officer of the State of
Florida., Division of Administrative Hearings and the Final Order entered by the Hearing Officer
determined that it was not in the public interest to place the entity submitting this sworn statement on
the convicted vendor list. [attach a copy of the final order.]
I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE PUBLIC ENTITY
INDENTIFIED IN PARAGRAPH I (ONE) ABOVE IS FOR THAT PUBLIC ENTITY ONLY, AND THAT THIS FORM IS VALID
THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED. I ALSO UNDERSTAND THAT I AM
REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE
THRESHOLD AMOUNT PROVIDED IN SECTION 287,017, FLORIDA STATUTES, FOR CATEGORY TWO OF ANY
CHANGE IN THE INFORMATION CONTAINED IN THIS FORM. „
Sworn to and subscribed before me this _� 2 4 � _ day of,
.Personally known
OR Produced identification..
(Type of identification)
Form FUR 7068 (Rev.06/11t92)
Thomas F. Pepe
12.5 -14
.Notary Publics- State 4 !-
My commission expires .+7" 2 �ao ;/�i1
(Printed, typed or stamped commissioned
name of notary public)
SAM L ORS ltd,
MIKA
i2!*tARIh:Z�1 x. &v' Vii {� �!'•.� ��U�i • =/f u �'
�gs'�titA+!�'1ttAt. t �i�ptWveya:.%w�Kw�
Whenever two or more .Bids or Proposals which are equal with respect to price, quality and service are received
by the State or by any political subdivisions for the procurement of commodities or contractual services, a Bid or
:Proposal received from a business that certifies that it has implemented a drug -free workplace program shall be
given preference in the award process. Established procedures for processing tie Bids or Proposals shall be
followed if none of the tied vendors have a drug -free workplace program. In order to have a drug -free workplace
program, a business shall:
I) Publish statement notifying employees that the unlawful manufacture, distribution, dispensing,
possession, or use of a controlled substance is prohibited in the workplace and specifying the
actions that shall be taken against employees for violations of such prohibition.
2) Inform employees about the dangers of drug abuse in the workplace, the business' policy of
maintaining a drug -free workplace, any available drug counseling, rehabilitation, and employee
assistance programs, and the penalties that may be imposed upon employees for drug abuse
.violations.
3) Give each employee engaged in providing the commodities or contractual services that are under
Bid a copy of the statement specified in Subsection (1).
4) In the statement specified in Subsection (1), notify the employees, that, as a condition of working
of the commodities or contractual services that are under Bid, he employee shall abide by the
terms of the statement and shall notify the employee of any conviction of, or plea of guilty or
riolo contendere to, any violation of Chapter 893 or of any controlled substance law of the United
States or any state, for a violation occurring in the workplace no later than five (5) business days
after such conviction.
5) Impose a sanction on, or require the satisfactory participation in a drug abuse assistance or
rehabilitation program, if such is available in the employee's community, by any employee who is
so convicted.
5) Make a good faith effort to continue to maintain a drug -free workplace through implementation
of this section.
As the person authorized to sign the statement, I certify that this firm complies fully with the above requirements,
a"tri' ^-v= 1,6—
RESPONDENT's Signature: = - -°
4,
Print Name: iZgIYLI V"-• =�,
Date:
Page 30 of 80
Thomas F. Pepe
12 -5 -14
ACKNOWLEDGEMENT OF CONFORMANCE WITH OSHA STANDARDS
TO THE CITY OF SOUTH MIAMI
We, . LEADEX CORPORATION (Name of CONTRACTOR), hereby acknowledge and agree that as
CONTRACTOR for the "Playground Demolition and New installation at Four (4) City Parks" project
as specified have the sole responsibility for compliance with all the requirements of the federal Occupational
Safety and Health Act of 1970, and all State and local safety and health regulations, and agree to Indemnify and hold
harmless the City of South Miami and WA (Consultant) against any and all liability, claims, damages, losses
and expenses they may incur due to the failure of (Sub - contractor's names):
NO SUBCONTRACTORS IN THIS JOB
to comply with such act or regulation. g"
CONTRACTOR i !
LEADEX CORPORATION r ✓
Witness
BY r
Name K'RA„NK J FONSECA, P.E.
PRESIDENT
Title
END OF SECTION
Page 31 of 80
Thom+. F. Pepe
12.5.14
I f/? � tVh< `�t F-0 fV E(Y C` % , individually and on behalf of /. � y I — ) I
( °Firm °)have Name of Representative CompanylVendorlEntity read the City of South Miami ( ".City" )'s Code of Ethics,
Section 8A -I of the City's Code of Ordinances and I hereby certify, under penalty of perjury that to the best of my
knowledge, information and belief:
(1) neither I nor the Firm have any conflict of interest (as defined in section 8A -1) with regard to the contractor
business that 1, and /or the Firm, am(are) about to perform for, or to transact with, the
City, and
(2) neither I nor any employees, officers, directors of the Firm, nor anyone who has afinancial interest greater
than S% in the firm, has any relative(s), as defined in section 8A -I, who is an employee of the City or who is(are)
an appointed or elected official of the City, or who is(are) a member of any public body created by the City
Commission, i.e., a board or committee of the City, [while the ethics code still applies, if the person executing this
:form is doing so on behalf of a firm whose stock is publicly traded, the statement in this section (2) shall be based
solely on the signatory's personal knowledge and he /she is not required to make an independent investigation as to
the relationship of employees or those who have a financial interest in the Firm.]; and
(3) neither I nor the Firm, nor anyone who has a financial interest greater than 5% in the Firm, nor any member of
:those persons' immediate family (i.e., spouse, parents, children, brothers and sisters) has transacted or entered
into any contract(s) with the City or has a financial interest, direct or indirect, in any business being transacted
with the city, or with any person or agency acting for the city, other than as follows:
sY eiI-V
._(use (if necessary, use a separate sheet to supply additional information that will not fit on this line; however, you
:must make reference, on the above line, to the additional sheet and the additional sheet must be signed under
:oath). [while the ethics code still applies, if the person executing this form is doing so on behalf of a firm whose
stock is publicly traded, the statement in this section (3) shall be based solely on the signatory's personal
.knowledge and he /she is not required to make an independent investigation as to the relationship of those who
have a financial interest in the Firm.]; and
(4) no elected and /or appointed official or employee of the City of South Miami, or any of their immediate family
members (i.e., spouse; parents, children, brothers and sisters). has a financial interest, directly or indirectly, in the
contract between you and /or your Firm and the City other than the following individuals whose interest is set
forth following their use a separate names: /VV I - ,e-- --
(if necessary, use a separate sheet to supply additional information that will not fit on this line; however, you must
make reference, on the above line, to the additional sheet and the additional sheet must be signed under oath).
The names of all City employees and that of all elected andlor appointed city officials or board members, who
own, directly or indirectly, an interest of five percent (5 %) or more of the total assets of capital stock in the firm
are as follows: /
f), V J ✓ •
:(if necessary, use a separate sheet to supply additional information that will not fit on this line; however, you must
make reference, on the above line, to the additional sheet and the additional sheet must be signed under oath).
.[while the ethics code still applies, if the person executing this form is doing so on behalf of a firm whose stock is
publicly traded, the statement in this section (4) shall be based solely on the signatory's personal knowledge and
helshe is not required to make an independent investigation as to the financial interest in the Firm of city
employees, appointed officials or the immediate family members of elected and /or appointed official or employee.]
(5) 1 and the Firm further agree not to use or attempt to use any knowledge, property or resource which may
come . to us through our position of trust, or through our performance of our duties under the terms of the
contract with the City, to secure a special privilege, benefit; or exemption for ourselves, or others, We agree that
we may not disclose or use information, not available to members of the general . public, for our personal gain or
benefit or for the personal gain or benefit of any other person or business entity, outside of the normal gain or
benefit anticipated through the performance of the contract.
Page 32 of 86
Thomas F. Pepe
I2 -5.14
(b) 1 and the Firm hereby acknowledge that we have not contracted or transacted any business with the City or
any person or agency acting for the City, and that we have not appeared in representation of any third party
before any board, commission or agency of the City within the past two years other than as
follows: O /V',s?':.
(if
necessary, use a separate sheet to supply additional information that will not fit on this line; however, you must
make reference, on the above line, to the additional sheet and the additional sheet must be signed under oath).
X:\Purchasing \Vendor Registration\ 12.28.12 RELATED PARTY TRANSACTION VERIFICATION FORM [3].docx
(7) Neither I nor any employees, officers, or directors of the firm, nor any of their immediate family (i.e., as a
'spouse, son, daughter, parent, brother or sister) is related by blood or marriage to: (i) any member of the City
Commission; (ii) any city employee; or (iii) any member of any board or agency of the City other than as follows:
/) /If .I'V4 -1-.- (if necessary, use a separate sheet to supply additional
information that will not fit on this line; however, you must make reference, on the above line, to the additional
sheet and the additional sheet must be signed under oath). [while the ethics code still applies, if the person
executing this form is doing so on behalf of a firm whose stock is publicly traded, the statement in this section (7)
shall be based solely on the signatory's personal knowledge and he /she is not required to make an independent
investigation as to the relationship by blood or marriage of employees, officers, or directors of the Firm, or of any
of their immediate family to any appointed or elected officials of the City, or to their immediate family. members].
(8) No Other Firm, nor any officers or directors of that Other Firm or anyone who has a financial interest greater
than 5% in that Other Firm, nor any member of those persons immediate family (i.e., spouse, parents, children,
brothers and sisters) nor any of my immediate family members (hereinafter referred to as "Related Parties ") has
responded to a solicitation by the City in which I or the Firm that I represent or anyone who has a financial
interest greater than 5% in the Firm, or any member of those persons' immediate family (i.e. spouse, parents,
children, brothers and sisters) have also responded, other than the following:
i'VOJV (,,— (if
necessary, use a separate sheet to supply additional information that will not fit on this line; however, you must
make reference, on the above line, to the additional sheet and the additional sheet must be signed under oath).
[while the ethics code still applies, if the person executing this form is doing so on behalf of a firm whose stock is
publicly traded, the statement in this section (8) shall be based solely on the signatory's personal knowledge and
he/she is not required to make an independent investigation into the Other Firm, or the Firm he /she represents, as
to their officers, directors or anyone having a financial interest in those Firms or any of their any member of those
persons' immediate family.]
(4) I:and the Firm agree that we are obligated to supplement this Verification Form and inform the City of any
change in circumstances that would change our answers to this document.. Specifically, after the opening of any
responses to a solicitation, I and the Firm have an obligation to supplement this Verification Form with the name of
all Related Parties who have also responded to the same solicitation and to disclose the relationship of those
parties to me and the Firm.
(10) A violation of the City's Ethics Code, the giving of any false information or the failure to supplement this
Verification Form, may subject me or the firm to immediate termination of any agreement with the City, and the
imposition of the maximum fine . and/or any penalties allowed by law. Additionally, violations may be considered by
and subject to action by the Miami -Dade County Commission on Ethics. Under penalty of perjury, I declare that I
have made a diligent effort to investigate the matters to which I am attesting hereinabove and that the statements
made hereinabove are true pr}djcorrect to the best of my knowledge, information and belief.
%.
Signature:_
Print Name & Title: f "/Zr7tV<J T. /vtV.' "et"ct,
Date: /.
ATTACHED:
Page 33 of 80
Thomas F. Pepe
12 -5 -IA
SCO 11, (30VERNOR
KFN LAA'SON. SECHT IARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD
C0
V - 7,K
L-L - 1 -11 1
_
he F:,ZK_ C T
ERAL 0NRACT6_R'
T _
Named beIo,,,) CERTIFIED
U nd,,.i the prov sbns ofCha0 pter,'8cl FS
p_x p; r a t � o n d at e A U G 31 1 2 16
FONSF'Ci"�, FRANK J
i, EADE_ X CORPOFWO-10N
601 S�,%/ 61TH C,, _r
MIAMI FI_ 33155
DISPLAYAS REOIJIR[�,D BY LAlJ%/ SEO�:
Local Business Tax Receipt
Miarni-Dade County, State of Florida
- HAS IS NU i A HILL 100 1 PAY
2224731
nusirmss PummmocivriniN
LEADEX CORP
2601 SW 69 C1
MIAMI FL 331 �)5
CA WN lift
U ADEX CORP
VVc)tker�s)
MWEIPT NO
RENEWAL
"<� 3 3 95 121
SEEPTERABEER 30, 201 E5
Munt fay otmOv"I at low of
Pllr";Ijilm VI C(mfov Codo
(Awfitet 8A - Aft 9 1r-1
S El C:, T Y P f! 0 1: 13 U S I N F G 11 PAYMENT RECEWL-0
1116 GUGHAL UJIL3.006 (:QJ FRM FOR BY TAX COLLECTOR
C:
`t 0, 161 it slumm ofui/awl
CREDITCARD— 1,1-03-'5601
This Local Elul ass Tax nnceWl only nunfinns pap"m of The Local HuAnus; Tax. 1hu Itucaft is not as hCeirse,
pemit or a cart hicadn" a! lhu holder 1 qualklma0unm to do himiness, J?oltjut toust comply with any governmnad
or monq"Vernmental regubwry laws and ruqu^.,camnt,; which apply to thil, business,
The RECEIPT MY ahovu musl his displayed (in all a aarratrac ra.iarl vo iicles -- Miami-Dafle Godu Son Ba-276
EV Innn) informabon, Viso wvvvwv 111joroillotle qnV!1oXfo1jvrAor
LEADCOR -02 KKENNEDY
1
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM1DDNYYY)
12131/2014
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
Collinsworth, Alter, Lambert, LLC
23 Eganfuskee Street
Suite 102
CONTACT
NAME: Dianthe Charron
PHONE, Fa
A E t ; - rc No): (661) 427 -6730
E -MAIL
ADDRESS: dcharron@callic.com
INSURERS AFFORDING COVERAGE I
NAIC 0
Jupiter, FL 33477
INSURER A: Association Insurance Co 111240
-A
INSURED
INSURER B:
INSURER C:
S 1 +000,00
Leadex Corporation
S 100,00
2601 SW 69 Court
INSURER D:
INSURER E:
01/0112015
Miami, FL 33155
INSURER F:
MED EXP (Any one person)
$ 5,00
^t--e-r r O%A rC w11 MAMCO. KI•VI`SIUN NLJn"15CK:
%;Uv=KAUMQ vcr%I,r wr%. a- .w...va -..
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
South Miami, City of Building Department
POLICY NUMBER
POLICY
IDDIYYYY
MMIDDIYYYP Y
LIMITS
AUTHORIZED REPRESENTATIVE
A
X
COMMERCIAL GENERAL LIABILITY
-A
EACH OCCURRENCE
S 1 +000,00
PREMISES Ea occurrence
S 100,00
CLAIMS -MADE 0 OCCUR
GLP013890302
01/0112015
01101!2016
MED EXP (Any one person)
$ 5,00
PERSONAL & ADV INJURY
$ 1,000,00
GE L AGGREGATE LIMIT APPLIES PER:
N
POLICY F PRO-- F—] LOC
GENERAL AGGREGATE
$ 2,000,00
PRODUCTS - COMP/OP AGG
S 2►000,00
S
OTHER:
AUTOMOBILE LIABILITY
BINED NGLE LIMIT
Ea accident
$
BODILY INJURY (Per person)
$
ANY AUTO
ALL AUTOS ED SCHEDULED
AUTOS
HIRED AUTOS OT OWNED
AU
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB
CLAIMS -MADE
DED RETENTION$
WORKERS COMPENSATION
X STATUTE �H-
R
$
E.L. EACH ACCIDENT
$ 1,000,00
A
AND EMPLOYERS' LIABILITY Y l
ANY PROPRIETORIPARTNERIEXECUTIVE aN
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
NIA
A
WCV013862902
0110112015
01/0112016
E.L. DISEASE - EA EMPLOYEE
$ 1,000,00
E.L. DISEASE - POLICY LIMIT
$ 1,000,00
DESCRIPTION OF OPERATIONS ! LOCATIONS ! VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
The Certificate Holder is named as an Additional Insured including products and completed operations for General Liability when required by written contract.
General Liability is primary and non - contributory when required by written contract. Waiver of Subrogation applies In favor of the certificate holders for
General Liability and Workers' Compensation when required by written contract Cancellation applies as per policy terms, conditions and exclusions.
Certificate holder is expanded to read : City of South Miami Beach
CERTIFICATE HULUtK
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
South Miami, City of Building Department
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
6130 Sunset Drive, 2nd Floor
South Miami, FL 33125
AUTHORIZED REPRESENTATIVE
-A
V 1.70014&V,Y MVV11v vv1Nr%05%mg W.V. ^....to ....+�
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
zt
to
City of Fe
Frank daker, AIAx
City of Fort Lauderdale
to
has met the requirements of the standards set forth by the
National rti ati Board
and is hereby grated certification as
Certified Playground Sa y Inspector
° � ry lc srt:e�t
NATIONAL, CERI1FICK110N BOARD CHAIRPERS ON
NRPA PRESIDENT AND CICa _._..
Certified
� Pla7ground
S Inspector
t
DAFT, CER l"fF7ED
CERTIFI €"ANON NNUMBLH
EXPIRATION DATI